Healthcare Provider Details

I. General information

NPI: 1073427654
Provider Name (Legal Business Name): CORDELE 2025 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 16TH AVE
CORDELE GA
31015-2461
US

IV. Provider business mailing address

502 W 16TH AVE
CORDELE GA
31015-2461
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-5282
  • Fax:
Mailing address:
  • Phone: 718-710-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ABDUL R ZAFAR
Title or Position: EMPLYEE
Credential: OWENER
Phone: 718-710-5282